Erasmus Mundus Doctoral Programme in Sustainable Industrial Chemistry SINCHEM APPLICATION FORM 2017/2018 Action 1 EMJD Please select one of the following categories you are applying for: Partner Country Fellowship: These fellowships are awarded to doctoral candidates who come from a Country other than an eligible applicant Country (see below) and who are not residents nor have carried out their main activity (studies, work, etc.) for more than a total of 12 months over the last five years in one of these Countries. The only exception to this rule applies to doctoral candidates who have previously received and Erasmus Mundus masters scholarship in order to follow an Erasmus Mundus Master Course (EMMC) Note: The Partner Country Fellowship candidates are Third-country nationals, meaning that they are not from any of the 28 EU Member States nor from any of the following non EU Programme Countries: Iceland, Norway, Liechtenstein, Turkey and Former Yugoslav Republic of Macedonia). Programme Country Fellowship: These fellowships are awarded to doctoral candidates who do not fulfil the Partner Country criteria defined above. 1
Instructions 1. Save as.pdf file a scanned copy of the signed and duly filled in application form (please, name the file: NAME_ApplicationForm.pdf); 2. Register on the official SINCHEM website (www.sinchem.eu), then login and upload as.pdf files all the mandatory documents (please, put them in order as indicated at page 13); 3. If your application has been successfully submitted, you will receive an acknowledgement receipt by e-mail. Only applicants with complete application will be acknowledged and will be contacted for further matters. If you do not receive such an acknowledgement within 7 days after the submission date, please contact us immediately; 4. This application can be a. submitted on-line OR b. sent by ordinary mail (hard copies) to the following address: SINCHEM Secretariat Dipartimento di Chimica Industriale Toso Montanari Viale Risorgimento, 4 Bologna 40136 Italy Application deadline 20th January 2017 Applications received after the deadline will be rejected. It is the applicants responsibility to check that the procedure is correctly accomplished. 2
1. PERSONAL DATA (Please enclose a copy of your passport together with a passport-sized photo) Family Name: Given Name: Date of Birth: (DD/MM/YYYY) / / Gender: Male Female Place of Birth: Nationality: Marital status : Single Married Registered partnership Number of children: Yes No Do you have a residence permit? Please specify: Do you need a visa for Europe? yes no Please specify: NOTE: it is the applicants responsibility to obtain a visa once accepted for this program. 2. CONTACT DETAILS/CURRENT ADDRESS Street, number: P.O. Box: City Country: Postal Code: Phone Number: Fax Number: E-mail: Skype ID: The candidate undertakes to communicate each/any change in residence or address as soon as possible. 3
Person to be contacted in case of emergency: Name: Relationship: Street and number: Postal code: City: Country: e-mail: Telephone (home number): (country code area code phone number) 3. ACADEMIC QUALIFICATIONS: Please enclose the digital copy of the degree, the academic transcript containing the list of exams and the scores and any other academic certificate. Note that all of the above mentioned documents have to be translated into English. For applicants whose Master s degree is to be awarded after the deadline of this call: remember to enclose the list of exams translated into English. A/ Undergraduate Degree(s): Type of degree: Institution: Field/Subject of the degree: Graduation date: Cumulative GPA 1 (Grade Point Average): Ranking (out of how many students): B/ (Post)-Graduate Degree(s): Type of degree: Institution: 1 GPA: The cumulative GPA (Grade Point Average) is usually mentioned clearly on your academic transcript. If this is not the case, please ask your university to calculate and provide proof of your cumulative GPA. 4
Field/Subject of the degree: : Specialization: Date of graduation: Cumulative GPA 1 (Grade Point Average): Ranking (out of how many students): Master s Thesis Please, provide details about the Master s thesis mentioned above. For applicants whose Master s degree is to be awarded after the deadline of this call: remember to specify the title of the thesis, a short summary and contact details of the supervisor. Title of the Master s Thesis Contact details of your supervisor Summary of the Master s Thesis If you have more than one degree, please specify the type of the degree, the name of the awarding institution, the topics and the date of graduation: 5
4. BACKGROUND: Please, enclose your CV (European Format exclusively) and a motivation letter in English. 5. WORKING EXPERIENCE Please, provide evidence of your working experience as indicated below A/ Last or current employer: Type of organisation/enterprises/laboratory: Working place: Starting date of the contract: Expiration date of the contract: Position held: Reason for the expiration of the contract: Main duties: Supervisor contact name: email: Phone: + B/ Previous employer: Type of organisation/enterprises/laboratory: Working place: Starting date of the contract: Expiration date of the contract: Position held: Reason for the expiration of the contract: Main duties: Supervisor contact name: email: Phone: + C/Previous employer: Type of organisation/enterprises/laboratory: Working place: Starting date of the contract: Expiration date of the contract: Position held: Reason for the expiration of the contract: Main duties: Supervisor contact name: email: Phone: + 6
Other professional information: Relevant skills acquired: 5. COURSES/SEMINARS/CONFERENCES RECENTLY ATTENDED, IF ANY Please, provide both dates and a short description of each 6. LANGUAGES SKILLS Please, specify the foreign language proficiency you have got, in English or other languages, by indicating below the following data according to the Common European Framework of Reference for Languages: http://www.coe.int/t/dg4/linguistic/cadre1_en.asp. Mother tongue: Language of instruction of your university Master s degree: A/ English Language Proficiency: Date of the test: Score: B/ Other languages Language Listening Speaking Reading Writing A1 Beginner A2 Elementary B1 Intermediate B2 Upper intermediate C1 Advanced C2 Proficiency 7
7. REFERENCES Please enclose two recommendation letters. Such letters can also be sent directly by writers to the SINCHEM email address: sinchem@unibo.it Recommendation letter 1 Author of the letter: Organisation: Address: Position: Email: Telephone: Recommendation letter 2 Author of the letter: Organisation: Address: Position: Email: Telephone: 8. I WOULD LIKE TO APPLY FOR THE FOLLOWING SINCHEM PROJECTS Please rank (from 1 as the most favourite till 4 as the last favourite) your favourite projects contained in the SINCHEM Project Catalog (www.sinchem.eu) NOTE: Please be aware that you may not be assigned your most favourite project. SINCHEM PROJECT PREFERENCE ORDER If you will not be assigned your first option, do you still want to enrol in the SINCHEM PhD Programme? Yes No 9. FUNDING Please note that PhD candidates must be able to afford their study and living and basic expenses. EM fellowships are assigned on the basis of the academic and professional evaluation only, not on the basis of the economic conditions. Funding available If yes, what kind: Private funder Available scholarship Expected scholarship Employer 8
I would like to apply for an Erasmus Mundus action 1 scholarship (in such a case fill in the next form). I would like to apply also without an Erasmus Mundus action 1 scholarship. 10. SPECIAL CIRCUMSTANCES Please indicate physical or learning disabilities/particular problems, if any. Max. 500 characters Pursuant to the Directive 95/46/EC of the European Parliament and of the Council of 24 October 1995 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, all data and information provided by the applicants/candidates will be used for institutional purposes only, both at national and at international level. I HEREBY DECLARE UNDER MY OWN RESPONSIBILITY that all data entered in the system are true. I AM AWARE THAT, in case of false statements, forgery of documents and use of false deeds, the applicant is prosecuted with penal sanctions under the law. Date Signature 9
ERASMUS MUNDUS ACTION 1 SCHOLARSHIP In the last 5 years, have you spent more than 12 months carrying out your main activities (studies, work etc.) in any of the EU member states or in Iceland, Liechtenstein, Norway, Turkey, FYRoM. No Yes, specify: Have you already benefited from an Erasmus Mundus Joint Doctorate fellowship in the past? No Yes, specify: : Have you already applied to other Erasmus Mundus Master and/or Erasmus Mundus Doctorate Programme for the academic year 2016-2017? No Yes, specify: : NOTE: Applicants who benefited from an EM Doctoral fellowship in the past are not eligible. Applicants can apply for a maximum of 3 different Erasmus Mundus Master s Courses (EMMC) and/or Erasmus Mundus Joint Doctorate Programmes (EMJD) starting in the same academic year. Applicants who participated in more than 3 EMMCs and/or EMJDs will be excluded from the selection. How did you learn about SINCHEM?: SINCHEM website Advertisement in magazine/paper EACEA website Brochure Partner university Euraxess website Alumni Friends Other, specify: 10
DECLARATION BY THE CANDIDATE I hereby forward the formal request for the admission to the selection for the Erasmus Mundus Doctorate in Sustainable Industrial Chemistry - SINCHEM. I certify that: 1. I have read all the application instructions; 2. The information and supporting documents I have provided are accurate, true and correct to the best of my knowledge. I am aware that any misrepresentation may result in the withdrawal of my admission or appointment; 3. The submission of this application does not guarantee my right to be admitted in the SINCHEM Programme; 4. If I will benefit from an EMJD fellowship, I will not benefit from any other EU grants while carrying out my Erasmus Mundus doctoral activities; 5. I am not currently under any criminal charges. I agree that the application and all the enclosed documents will be archived at the SINCHEM Consortium premises. I authorize the SINCHEM Consortium, pursuant to the Italian Laws 196/2003 ( Codice in materia di protezione dei dati personali ) and 271/2009 ( Testo unico sulla privacy e sull utilizzo dei sistemi informatici ), to use the personal information provided only for institutional purposes. I am aware that all the documents submitted will not be given back to me. Place and Date: Name of the applicant: Signature 11
CHECKLIST Use the enclosed cover page (see the template available below) If you want to apply for an EM scholarship, you have to fill in the relevant section in the application form REQUIRED DOCUMENTS Please ensure that all the following annexes are enclosed to your application: Detailed Curriculum vitae, Standard European Format only; no other format will be accepted. (see: http://europass.cedefop.europa.eu/europass/home/hornav/introduction.csp) Copy of the academic degree(s) in original language together with the translation into English, and the final grade. Copies of the official transcripts (mark sheets) of academic courses attended to obtain each degree (Bachelor s, Master s or equivalent) with translation in English, and Grade Point Average. Signed Motivation Letter in English (maximum one page) specifying the reasons why you have chosen the SINCHEM Programme, which skills and abilities make you a good candidate for SINCHEM, your motivations to carry out research abroad, your professional interest in carrying out your research in Europe; Two reference letters signed by a university lecturer, researcher or an expert in the area of Sustainable Industrial Chemistry. Letters must be printed on letterhead and duly signed. Such letters can also be sent directly by writers to the SINCHEM email address: sinchem@unibo.it Official proof of English language proficiency, providing evidence of the applicant s level of proficiency of the English language. For those who studied in countries where English is the official language, an official letter stating that your university studies were undertaken in English. Any other qualifications related to the research areas and topics of the SINCHEM Programme. 1 scanned passport-sized photo Copy of all the pages of your international passport. If any of the above required annexes is missing, your application will be considered incomplete and will be disregarded. 12
TEMPLATE COVER PAGE Surname: Full name: Nationality: E-mail: This envelope contains the following documents: Date: / / DOCUMENT Application form 1. CV 2. Degree certificate/diploma and Academic Transcript 3. Motivation letter 4. Recommendation letters 5. English test result 6. Other qualifications 7. Photo 8. Copy of passport Signature: 13